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| The first 150 words of the full text of this article appear below. |
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Introduction |
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The transjugular intrahepatic portosystemic stent-shunt (TIPSS)
has been a clinical reality for the past 10 years. The procedure is
essentially a side-to-side H graft portosystemic shunt, with the
expandable metallic stent being the H graft. Over this time, TIPSS has
been put through the paces of assessment of technical feasibility,
pilot studies through to randomised clinical trials looking at
treatment of complications of portal hypertension. Following its
introduction, there was an enthusiastic welcome for this procedure
which was seen as an attractive alternative to shunt surgery
it did
not require general anaesthesia (most of the time) or a laparotomy, and
was applicable to many patients with severe liver disease unsuitable
for surgery. Treatment of variceal haemorrhage, ascites, hepatic
hydrothorax, hepatorenal syndrome, and Budd-Chiari syndrome using TIPSS
has been studied. The initial enthusiasm was subsequently tempered by
reports from these studies of shortcomings of TIPSS, namely the
inevitable development of
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